同期与分期行双侧全髋关节置换术的安全性及短期临床疗效比较  

Comparison of short-term clinical outcomes and safety between synchronous and staged bilateral total hip arthroplasty

作　　者：乔高山[1] 朱乐银[1] 朱成栋[1] 印文彩 夏建忠[1] 黄华[1] 

机构地区：[1]仪征市人民医院(扬州大学医学院附属仪征医院)骨关节外科,江苏仪征211400

出　　处：《骨科》2016年第3期185-189,共5页ORTHOPAEDICS

摘　　要：目的比较同期与分期行双侧全髋关节置换术（total hip arthroplasty,THA）的安全性及短期临床疗效。方法回顾性分析2008年1月至2014年6月收治的行双侧THA的患者55例（110髋）,同期行双侧THA的25例纳入同期组,分期行双侧THA的30例纳入分期组。比较两组患者的围术期相关情况以及术后并发症、功能恢复、肢长差异等。结果 55例患者术后均获随访,随访时间1.5~3.0年,平均1.8年。两组在总住院时间和住院费用方面,差异有统计学意义（t=-9.73,P=0.035;t=-2.39,P=0.041）;同期组和分期组各有1例患者术后出现深静脉血栓形成;同期组2例患者出现神经精神系统症状,分期组1例;两组患者术前及术后1年的Harris评分差异均无统计学意义,但两组患者术后1年的评分均较术前显著提高,差异有统计学意义（t=3.987,P=0.023;t=4.213,P=0.019）;同期组和分期组术后肢长差异分别为（0.16±0.34）cm、（0.47±0.39）cm,差异有统计学意义（t=-3.57,P=0.023）。结论严格把握适应证、选择合适的假体,同期与分期行双侧THA都是可行的,但在住院时间、住院费用、术后肢长差异方面,同期双侧THA更有优势。Objective To compare the clinical outcomes and safety of synchronous vs. staged bilateraltotal hip arthroplasty（THA）. Methods Fifty-five cases（110 hip joints） undergoing bilateral THA from January2008 to June 2014 were reviewed retrospectively： synchronous bilateral THA in 25 cases（synchronous group）and staged bilateral THA in 30 cases（staged group）. The patients between two groups were compared in aspectsof total operative time, intraoperative bleeding and postoperative drainage, total amount of blood transfusion, du-ration and cost of hospitalization, postoperative discrepancy in bilateral leg length, preoperative and postopera-tive function score and perioperative complications. Results The postoperative follow-up period was 1.5-3.0years（average of 1.8 years）. There were no statistical differences between synchronous group and staged groupin aspects of total operative time, intraoperative bleeding and postoperative drainage, total amount of blood trans-fusion, and postoperative function score. However, there was significant difference in the total length of stay andhospital costs between two groups（t=- 9.73, P=0.035; t=- 2.39, P=0.041）. In synchronous group and stagedgroup there was one case of deep vein thrombosis each; neuropsychiatric symptoms occurred in 2 cases of syn-chronous group and one case in staged group; preoperative and postoperative Harris score before and one yearafter operation showed no statistically significant difference between two groups, but that one year after opera-tion was significantly increased as compared with that preoperation in both two groups（t=3.987, P=0.023; t=4.213, P=0.019）. Postoperative limb length differences in synchronous group and staged group were（0.16±0.34）cm, and（0.47 ± 0.39） cm with the difference being statistically significant（t=- 3.57, P=0.023）. Conclusion Synchronous bilateral THA is safe and feasible as far as the patients＇ physical condition is allowed, periopera-tive management is rational and physicians have ma

关 键 词：关节成形术 置换 髋 同期 分期 安全性 

分 类 号：R687.4[医药卫生—骨科学]